Update of the PANCCO clinical practice guidelines for the treatment of ulcerative colitis in the adult population.

Ulcerative colitis (US) is a chronic disease of unknown etiology. It is incurable and its clinical course is intermittent, characterized by periods of remission and relapse. The prevalence and incidence of the disease has been increasing worldwide. The update presented herein includes the participation of healthcare professionals, decision-makers, and a representative of the patients, all of whom declared their conflicts of interest. Answerable clinical questions were formulated, and the outcomes were graded. The information search was conducted on the Medline/PubMed, Embase, Epistemonikos, and LILACS databases, and covered grey literature sources, as well. The search was updated on November 30, 2020, with no restrictions regarding date or language. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) classification system was implemented to establish the strength of the recommendation and quality of evidence. A formal consensus was developed, based on the RAND/UCLA methodology and the document was peer reviewed. The short version of the Clinical Practice Guidelines for the Treatment of Ulcerative Colitis in the Adult Population is presented herein, together with the supporting evidence and respective recommendations. In mild-to-moderate UC, budesonide MMX is an option when treatment with 5-ASA fails, and before using systemic steroids. In moderate-to-severe UC, infliximab, adalimumab, vedolizumab, ustekinumab, and tofacitinib can be used as first-line therapy. If there is anti-TNF therapy failure, ustekinumab and tofacitinib provide the best results. In patients with antibiotic-refractory pouchitis, anti-TNFs are the treatment of choice.

Primer consenso cubano sobre el uso de terapia convencional y biológica en pacientes con artritis reumatoide / First Cuban consensus on the use of conventional and biological therapy in patients with rheumatoid arthritis

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Introduction: The development of recommendations for the treatment of rheumatoid arthritis (RA) in the Cuban context may be one of the ways to achieve better control of this disease. Objective: To reach a consensus and update relevant aspects of conventional and biological RA modifier therapy in Cuba. Methods: 18 specialists from 8 Cuban provinces, experts in RA care, were summoned, according to the years of dedication to the specialty, the conferences on this topic and their publications. The first meeting took place in March 2016 in the provincial hospital of Villa Clara, Cuba, with the participation of all the experts. A review of the literature on conventional and biological therapy previously collected by the participants was developed, and two teams were formed: the first would address everything related to conventional therapy in RA (HRCT) and the other, biological therapy in RA (TBAR). Three questionnaires related to the use of corticosteroids, HRCT and TBAR, were prepared, answered by the participants via email. In a second meeting, held in October 2016 in Havana, the analysis of all the responses provided was carried out. Questions with a response of 90% or more votes were considered as recommendations. Results: The questionnaires were answered by 95% of the participants. 9 recommendations and 1 algorithm were established. The recommendations are as follows: methotrexate is the drug of choice in the treatment of RA after diagnosis; The administration of another conventional drug (DMARDc) (azathioprine, salazosulfapyridine, antimalarials and leflunomide) is recommended in patients with a diagnosis of active RA in whom methotrexate is contraindicated or there is a failure in response - consider the administration of low doses of prednisone or equivalent (<7.5 mg/d) associated with DMARDc in patients with active moderate to severe RA, for the shortest possible time; perform serological control including tests for hepatitis B and C viruses and screening for HIV in all patients diagnosed with RA before starting treatment with DMARDc and biologics; in patients in remission or, at least, with a DAS-28 below 3.2, consideration should be given to withdrawing one of the DMARDs or reducing, to the minimum possible expression, the dose of both disease modifiers; if methotrexate fails, tocilizumab in combination with methotrexate or as monotherapy will be indicated. Conclusions: Aspects related to conventional therapy with methotrexate, azathioprine, salazosulfapyridine, antimalarials and leflunomide were agreed. The value of early diagnosis and immediate initiation of DMARDc therapy and the use of glucocorticoids was analyzed. Treatment with tocilizumab, the only biological available in Cuba against RA, will be administered when there is a failure in the response to conventional therapy and combinations between these drugs. It is recommended to hold educational conferences through the mass media aimed at patientshttp(AU)

Receta electrónica: diferencias entre comunidades autónomas que afectan al acceso a los tratamientos y a la calidad de la atención farmacéutica / Electronic prescription: differences between autonomous communities affecting access to treatment and the quality of pharmaceutical care

FUNDAMENTO: Los sistemas de receta electrónica implantados en las distintas comunidades autónomas españolas presentan diferencias. Este trabajo trata de describir cómo afectan estas diferencias al acceso a los tratamientos y a la atención farmacéutica, y las características específicas que los facilitan. MÉTODOS: Se diseñó una encuesta para valorar los sistemas de receta electrónica que fue cumplimentada por los Centros de Información del Medicamento de los Colegios Oficiales de Farmacéuticos de todas las comunidades autónomas de España durante febrero y marzo de 2020. RESULTADOS: En todas las comunidades autónomas se registró alguna limitación respecto a la disponibilidad temporal del tratamiento, y en cinco de ellas se registraron incidencias relativas al modo de acceso a la receta electrónica. En ninguna comunidad las farmacias pueden resolver problemas de disponibilidad en circunstancias especiales, ni existe sistema de comunicación efectivo con el médico ni de registro de datos del paciente. Solo algunas comunidades gestionan determinadas sustituciones para adaptar la prescripción a los requerimientos del paciente. CONCLUSIONES: El sistema actual de receta electrónica podría optimizarse para evitar desigualdades entre comunidades autónomas y mejorar la calidad de la atención que reciben los pacientes, facilitando el acceso a los tratamientos y evitando desplazamientos y demoras. El acceso presentando solo la tarjeta sanitaria, la adaptación de las limitaciones temporales para evitar bloqueos, la dispensación en circunstancias especiales justificada y registrada por el farmacéutico, así como habilitar una comunicación eficiente farmacéutico-médico, son medidas generales que evitarían desigualdades y facilitarían el acceso a los tratamientos y la atención farmacéutica

BACKGROUND: The electronic prescription systems implemented in the different autonomous communities in Spain show differences. This study aims to describe how these differences affect access to treatment and pharmaceutical care, and what specific characteristics facilitate them. METHODS: A survey was designed to evaluate the electronic prescription systems. This survey was carried out at the Drug Information Centers of the Official Pharmacists' Colleges of all the Spanish autonomous communities during February and March 2020. RESULTS: In all autonomous communities there were some limitations regarding the temporary availability of the treatment, and incidents regarding the way of accessing the electronic prescription were recorded only in only five communities. In no community are pharmacies able to solve availability problems in special circumstances, nor is there any effective system for communicating with the doctor or recording patient data. Only some communities organize certain replacements to adapt the prescription to the patient's requirements. CONCLUSIONS: The current electronic prescription system could be optimized to avoid inequalities between autonomous communities and improve the quality of care received by patients, facilitating access to treatment, and avoiding the need to travel and delays. Access on presenting the health card, adaptation of time limitations to avoid blockages, dispensing medicines in special circumstances justified and registered by the pharmacist, as well as enabling efficient pharmacist-doctor communication, are general measures that avoid inequalities and facilitate access to treatments and pharmaceutical care

[Electronic prescription: differences between autonomous communities affecting access to treatment and the quality of pharmaceutical care].

BACKGROUND: The electronic prescription systems implemented in the different autonomous communities in Spain show differences. This study aims to describe how these differences affect access to treatments and pharmaceutical care, and what specific characteristics facilitate them. METHODS: A survey was designed to evaluate the electronic prescription systems. This survey was carried out at the Drug Information Centers of the Official Pharmacists' Colleges of all the Spanish autonomous communities during February and March 2020. RESULTS: In all autonomous communities there were some limitations regarding the temporary availability of the treatment, and incidents regarding the way of accessing the electronic prescription were recorded only in only five communities. In no community are pharmacies able to solve availability problems in special circumstances, nor is there any effective system for communicating with the doctor or recording patient data. Only some communities organize certain replacements to adapt the prescription to the patient's requirements. CONCLUSIONS: The current electronic prescription system could be optimized to avoid inequalities between autonomous communities and improve the quality of care received by patients, facilitating access to treatments, and avoiding the need to travel and delays. Access on presenting the health card, adaptation of time limitations to avoid blockages, dispensing medicines in special circumstances justified and registered by the pharmacist, as well as enabling efficient pharmacist-doctor communication, are general measures that avoid inequalities and facilitate access to treatments and pharmaceutical care.

Treatment of ankyloglossia with dental laser in paediatric patients: Scoping review and a case report.

AIM: The two aims of this article were to conduct a scoping review of current knowledge regarding laser treatment of ankyloglossia in children and to report a case of a male paediatric patient with ankyloglossia treated with laser surgery. METHODS: A comprehensive literature search was carried out on the following electronic databases: PubMed; Embase; Google Scholar; The Cochrane Library, and Dentistry and Oral Science Source (EBSCO). RESULTS: The initial search identified 278 references. After the process of title/abstract screening, 61 articles received a full-text reading; finally, 17 articles were selected. According to this scoping literature review, lingual frenulectomy managed with laser surgery provides a more efficient and comfortable treatment for both the paediatric patient and the dentist compared with conventional scalpel/blades/suturing techniques. Nevertheless, further high-quality studies on the clinical efficacy of laser devices for lingual frenulectomy in paediatric populations are required. CONCLUSION: Early diagnosis and treatment of ankyloglossia are fundamental for the adequate functional oral development of paediatric patients. Laser surgery for lingual frenulectomy provides a more efficient and comfortable treatment for both the child and the paediatric dentist compared to traditional scalpel/blade methods.

Immunomodulatory Therapy Does Not Increase the Risk of Cancer in Persons With Inflammatory Bowel Disease and a History of Extracolonic Cancers.

OBJECTIVES: Immunosuppressant therapies (IMTs; thiopurines, anti-tumor necrosis factor agents) may influence the immunologic control of cancer and might facilitate the spread and recurrence of cancer. This study assesses the impact of the use of IMTs on the development of incident cancers (recurrent or new) in patients with inflammatory bowel disease (IBD) and a history of malignancy. METHODS: Patients with IBD included in the ENEIDA registry with a history of cancer without being exposed to IMTs were identified and retrospectively reviewed and compared regarding further treatment with IMTs or not by means of a log-rank test. RESULTS: Overall, 520 patients with previous extracolonic cancer naive to IMTs before the diagnosis of cancer were identified. Of these, 146 were subsequently treated with IMTs (exposed), whereas 374 were not (nonexposed). The proportion of patients with incident cancers was similar in both exposed (16%) and nonexposed (18%) patients (P = 0.53); however, there was more than a 10-year difference in the age at index cancer between these 2 groups. Cancer-free survival was 99%, 98%, and 97% at 1, 2, and 5 years in exposed patients, and 97%, 96%, and 92% at 1, 2, and 5 years in non-exposed patients, respectively (P = 0.03). No differences in incident cancer rates were observed between exposed and nonexposed patients when including only those who were exposed within the first 5 years after cancer diagnosis. DISCUSSION: In patients with IBD and a history of cancer not related to immunosuppression, the use of IMTs is not associated with an increased risk of new or recurrent cancers even when IMTs are started early after cancer diagnosis.

Afasia en paciente con encefalopatía hepática aguda asociada a lesiones corticales cerebrales multifocales / Aphasia in a patient with acute hepatic encephalopathy associated with multifocal cortical brain lesions

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Wine aromatic compound production and fermentative behaviour within different non-Saccharomyces species and clones.

AIMS: Twenty-five enological yeasts belonging to nine different species (Candida zeylanoides, Cryptococcus uzbekistanensis, Debaryomyces hansenii, Lachancea thermotolerans, Metschnikowia pulcherrima, Torulaspora delbrueckii, Williopsis pratensis, Zygosaccharomyces bailii and Saccharomyces cerevisiae) were screened for aroma formation and fermentative behaviour as part of a non-Saccharomyces yeast selection programme. METHODS AND RESULTS: Pure cultures were inoculated in pasteurized grape juice in order to perform alcoholic fermentations. Some non-Saccharomyces species did not ferment, others did not get established and none of them completed alcoholic fermentations. The physico-chemical parameters of the wines and the abundance of aromatic compounds at the end of alcoholic fermentation highlighted the notable differences in the aroma-forming ability and fermentative behaviour of the different non-Saccharomyces species, but not within clones. CONCLUSIONS: Lower diversity was detected within non-Saccharomyces species than that reported in S. cerevisiae with regard to enological behaviour and aromatic profiles. Metschnikowia pulcherrima and L. thermotolerans are the two species with higher possibilities to become an inoculum. SIGNIFICANCE AND IMPACT OF THE STUDY: Few significant differences were found within clones of the same species, but very important parameters in wine quality, such as volatile acidity, ethyl acetate and acetoin, which would justify selection programmes within those species. The results also demonstrated that T. delbrueckii and L. thermotolerans are two close species in their aromatic profiles.

Haptic simulation of tissue tearing during surgery.

We present a method for the real-time, interactive simulation of tissue tearing during laparoscopic surgery. The method is designed to work at haptic feedback rates (ie, around 1 kHz). Tissue tearing is simulated under the general framework of continuum damage mechanics. The problem is stated as a general, multidimensional parametric problem, which is solved by means of proper generalized decomposition methods. One of the main novelties is the reduction of history-dependent problems, such as damage mechanics, by resorting to an approach in which a reduced-order field of initial damage values is considered as a parameter of the formulation. We focus on the laparoscopic cholecystectomy procedure as a general example of the performance of the method.

Genetic and phenotypic intraspecific variability of non-Saccharomyces yeasts populations from La Rioja winegrowing region (Spain).

AIMS: To determine the intraspecific genetic diversity within five non-Saccharomyces yeast species and the diversity in phenotypic characteristic related to their technological properties. METHODS AND RESULTS: Seventy-one non-Saccharomyces yeasts isolated from different fermentations and facilities of the DOCa Rioja (Spain) belonging to five different wine species (Torulaspora delbrueckii, Lachancea thermotolerans, Metschnikowia pulcherrima, Zygosaccharomyces bailii and Williopsis pratensis) were subjected to clonal characterization by RAPD-PCR, which evidenced wide diversity between them. They were also submitted to a screening for some oenological traits related to the improvement of the aroma of the wine and yeast development in musts. Strains within the same species showed different enzyme activities, tolerated different levels of SO2 and possessed different killer phenotypes. These characteristics made them adjust better or worse to specific vinification processes or wine quality criteria. CONCLUSIONS: A significant genetic and phenotypic variation within the non-Saccharomyces species studied was found, which makes necessary to carry out a selection process in each one. SIGNIFICANCE AND IMPACT OF THE STUDY: Williopsis pratensis, a species that has not been thoroughly explored, may deserve further consideration for oenological applications. Due to the wide range of variation within species, the strains adaptation to the SO2 levels in musts has to be taken into account in selection processes.

An index with improved diagnostic accuracy for the diagnosis of Crohn's disease derived from the Lennard-Jones criteria.

BACKGROUND: The Lennard-Jones criteria are considered the gold standard for diagnosing Crohn's disease (CD) and include the items granuloma, macroscopic discontinuity, transmural inflammation, fibrosis, lymphoid aggregates and discontinuous inflammation on histology. The criteria have never been subjected to a formal validation process. AIM: To develop a validated and improved diagnostic index based on the items of Lennard-Jones criteria. METHODS: Included were 328 adult patients with long-standing CD (median disease duration 10 years) from three centres and classified as 'established', 'probable' or 'non-CD' by Lennard-Jones criteria at time of diagnosis. Controls were patients with ulcerative colitis (n = 170). The performance of each of the six diagnostic items of Lennard-Jones criteria was modelled by logistic regression and a new index based on stepwise backward selection and cut-offs was developed. The diagnostic value of the new index was analysed by comparing sensitivity, specificity and accuracy vs. Lennard-Jones criteria. RESULTS: By Lennard-Jones criteria 49% (n = 162) of CD patients would have been diagnosed as 'non-CD' at time of diagnosis (sensitivity/specificity/accuracy, 'established' CD: 0.34/0.99/0.67; 'probable' CD: 0.51/0.95/0.73). A new index was derived from granuloma, fibrosis, transmural inflammation and macroscopic discontinuity, but excluded lymphoid aggregates and discontinuous inflammation on histology. Our index provided improved diagnostic accuracy for 'established' and 'probable' CD (sensitivity/specificity/accuracy, 'established' CD: 0.45/1/0.72; 'probable' CD: 0.8/0.85/0.82), including the subgroup isolated colonic CD ('probable' CD, new index: 0.73/0.85/0.79; Lennard-Jones criteria: 0.43/0.95/0.69). CONCLUSION: We developed an index based on items of Lennard-Jones criteria providing improved diagnostic accuracy for the differential diagnosis between CD and UC.

Proceso y oportunidades de la transferencia del conocimiento desde la psicología comunitaria a las políticas públicas / Process and Opportunities for Knowledge Transfer from Community Psychology to Public Policy

La literatura reporta una creciente incorporación y participación de la psicología comunitaria en políticas públicas, que genera obstáculos, tensiones y posibilidades. Cobra relevancia académica y profesional analizar los antecedentes sobre transferencia de conocimiento desde la psicología comunitaria hacia las políticas públicas. Se revisa y expone literatura respecto de las condiciones que afectan el vínculo entre la producción académica y las respuestas a los problemas sociales desde la perspectiva de las deliberative politcs, del proceso de encuentro y de la lucha de interpretaciones de actores como factor de cambio de las políticas públicas. Desde la psicología comunitaria, se analiza la complejidad de transferencia del conocimiento hacia las políticas públicas, concluyendo con recomendaciones para potenciar la contribución y comprender las tensiones reportadas.

The literature reports the growing incorporation and participation of community psychology on public policies, and considering the obstacles and tensions in this relationship as reported by literature,-it is both academically and professionally relevant to review the knowledge transfer from the academia to the policy making process. We review a body of literature regarding the link between academic production and the response to social problems, emphasizing the deliberative politics approach, with a description of stakeholders'confluent and conflicting interpretations as a factor of change for public policies. We also review the literature regarding the complexity of knowledge transfer from community psychology to public policy, as reported by this discipline, concluding with recommendations for enhancing its contribution and to understand the tensions reported.

Changes on grape phenolic composition induced by grapevine foliar applications of phenylalanine and urea.

Grapevines may require the input of nitrogen to grow and to guarantee an appropriate grape composition. Recently there has been a growing interest in foliar fertilization, which entails a fast and efficient assimilation of the products. The aim of this work was to study the influence of foliar applications of phenylalanine and urea, at two different doses, on grape anthocyanins, flavonols, flavan-3-ols, phenolic acids, and stilbenes. All treatments were applied at veraison and one week later at doses of 0.9 and 1.5 kg N/ha. The results showed that the synthesis of phenolic compounds was favoured by foliar applications of phenylalanine and urea. The application of the lowest dose of urea was the most effective treatment, increasing the content of several anthocyanins and flavonols. Moreover, none of the foliar treatments worsened the grape phenolic composition. In conclusion, foliar application of phenylalanine and especially urea, could be an interesting management tool for improving grape quality and their health-promoting properties.

Propiedades psicométricas de la Escala Breve Multidimensional de Satisfacción con la Vida para Estudiantes (BMSLSS) en población infantil chilena (10-12 años) / Psychometric Properties of the Brief Multidimensional Students' Life Satisfaction Scale (BMSLSS) in Chilean Students (10 - 12 years old)

Este trabajo analiza las propiedades psicométricas de la escala BMSLSS de Seligson, Huebner y Valois (2003) en niños y niñas chilenos. Se aplicó a 1096 estudiantes de 10, 11 y 12 años. Se realizaron análisis de confiabilidad, análisis factorial exploratorio (EFA) y confirmatorio (CFA) y correlación ítem con puntaje total. Los resultados exhiben una aceptable confiabilidad interna de la escala (a = 0.7), un solo factor en la estructura factorial de la escala y adecuada correlación ítem con puntaje total (entre 0.55 y 0.73). El estudio fundamenta el uso de BMSLSS en Chile en población infantil y aporta herramientas de medición de indicadores sociales para la infancia en países en vías de desarrollo de habla hispana.

This paper analyzes the psychometric properties of the Brief Multidimensional Students' Life Satisfaction Scale -BMSLSS (Seligson, Huebner and Valois, 2003) in Chilean children. 1096 Chilean students of 10, 11 and 12 years-old participated in the study. Reliability analysis, exploratory factor analysis (EFA), confirmatory factor analysis (CFA) and item correlation with total score were performed. Results show acceptable internal reliability of the scale (a = 0.7), a single factor structure of the scale and appropriate item correlation with total score (between 0.55 and 0.73) This study supports the use of the BMSLSS in children in Chile in the school context, and also provides measurement tools for social indicators for children in Spanish-speaking developing countries.